National College

Mihai Viteazul

Human
Rights
The Right To Special Care And Assistance
For Mothers And Children
Coordonating teacher: Anca
Negulescu Wright
Student:Petcu Beatris
Alexandra

Contents:

Preface

I. Mothers and children matter-so does their health

5

1. Mothers and children matter-so does their health

6

2.The Early years of maternal and child health

8

2
3.Where we are now???:box1.1,box1.2
13

4.Uneven gains in child health

14

5.Few signs of improvement:box 1.3

15

II.A continuum care to save newborn lives

16

1.Three Brazilian birth cohorts

19

2.Children’s Rights in Turkey

20

III.Mother’s rights

1.Single mother assistance

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2.Mothers know your rights!!!!

24

CODE OF GOOD PRACTCE ON PREGNANCY AND AFTER BIRTH

25

“You don't really understand

human nature unless you know why a child on a

3
merry-go-round will wave at his parents every time
around - and why his parents will always wave back.”

~William D. Tammeus

The right to special care and assistance for

mothers and children is a right that involves you as a person,
as an individual, you as a child and future mother.
The reason why I have chosen to talk about this
right is because in my opinion being a mother is the most
difficult “job” a person can have and mothers should have at
least the right to special care and assistance for her and for
her child.
Over the centuries woman’s rights have been
ignored and restricted to a life of “housekeeping”. As a
woman you would have to be a slave in your own body and
as a mother your rights would have been limited to give birth
and to raise the child until he has the perfect age for his
father to take control over him. The rights of a mother were
so deeply buried that if women didn’t gave birth to a boy, an
heir, she was rejected by her husband and even punished.
I think that it is time for us to take the mater more
serious because all woman face the same problem when
they are children and when they are mothers : their rights.
Even if you are a teacher ,even if you have your
own child or even if you adopt one you are still a mother ,
the most important person in the world ,the one who gives
birth to a new world ,the one who is there for you no mater
what time ,what place or reason ,the one who illuminates
you ,the one you will appreciate later on as the most
incredible “creature “you could have ever meet.

A mother is the most important achievement a

woman can have and nobody , not even the most brilliant
people in the world have been able to describe it.

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 “To describe my mother would
be to write about a hurricane in its perfect power. “
Maya Angelou

Human
Rights
Article 25/
(2)

Article 25.

(1) Everyone has the right to a
standard of living adequate for the
health and well-being of himself and
of his family, including food, clothing,
housing and medical care and
necessary social services, and the
right to security in the event of

5
 unemployment, sickness, disability,
widowhood, old age or other lack of
livelihood in circumstances beyond his
control.

(2) Motherhood and childhood are entitled
to special care and assistance. All children,
whether born in or out of wedlock, shall
enjoy the same social protectio

I. Mothers and children matter

-so does their health

The healthy future of society depends on the

health of the children of today and their mothers, who are
guardians of that future. However, despite much good work
over the years, 10.6 million children and 529 000 mothers
are still dying each year, mostly from avoidable causes. This
chapter assesses the current status of maternal and child
health programmes against their historical background. It
then goes on to examine in more detail the patchwork of
progress, stagnation and reversals in the health of mothers
and children worldwide and draws attention to the previously
underestimated burden of newborn mortality. Most pregnant
women hope to give birth safely to a baby that is alive and
well and to see it grow up in good health. Their chances of
doing so are better in 2005 than ever before – not least

6
because they are becoming aware of their rights. With
today’s knowledge and technology, the vast majority of the
problems that threaten the world’s mothers and children can
be prevented or treated. Most of the millions of untimely
deaths that occur are avoidable, as is much of the suffering
that comes with ill-health. A mother’s death is a tragedy
unlike others, because of the deeply held feeling that no one
should die in the course of the normal process of
reproduction and because of the devastating effects on her
family (1). In all cultures, families and communities
acknowledge the need to care for mothers and children and
try to do so to the best of their ability.
An increasing number of countries have
succeeded in improving the health and well-being of
mothers, babies and children in recent years, with noticeable
results. However, the countries with the highest burden of
mortality and ill-health to start with made little progress
during the 1990s. In some, the situation has actually
worsened in recent years. Progress has therefore been
patchy and unless it is accelerated significantly, there is little
hope of reducing maternal mortality by three quarters and
child mortality by two thirds by the target date of 2015 – the
targets set by the Millennium Declaration (2, 3).In too many
countries the health of mothers and children is not making
the progress it should. The reasons for this are complex and
vary from one country to another. They include the familiar,
persistent enemies of health – poverty, inequality, war and
civil unrest, and the destructive influence of HIV/AIDS – but
also the failure to translate life-saving knowledge into
effective action and to invest adequately in public health and
a safe environment. This leaves many mothers and children,
particularly the poorest among them, excluded from access
to the affordable, effective and responsive care to which
they are entitled. For centuries, care for childbirth and
young children was regarded as a domestic affair, the realm
of mothers and midwives. In the 20th century, the health of
mothers and children was transformed from a purely

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domestic concern into a public health priority with
corresponding responsibilities for the state.
2. THE EARLY YEARS OF MATERNAL
AND
CHILD HEALTH

The creation of public health

programmes to improve the health of women and children
has its origins in Europe at the end of the nineteenth
century. With hindsight, the reasons for this concern look
cynical: healthy mothers and children were seen by
governments at that time to be a resource for economic and
political ambitions. Many of Europe’s politicians shared a
perception that the ill-health of the nation’s children
threatened their cultural and military aspirations. This
feeling was particularly strong in France and Britain, which
had experienced difficulties in recruiting soldiers, fit enough
for war. Governments saw a possible solution in the
pioneering French experiments of the 1890s, such as Léon
Dufour’s Goutte de lait (drop of milk) clinics and Pierre
Budin’s Consultations de nourrissons (infant welfare clinics).
These programmes offered a scientific and convincing way
to produce healthy children who would become productive
workers and robust soldiers. The programmes also
increasingly found support in the emerging social reform and
charitable movements of the time. As a result, all
industrialized countries and their colonies, as well as
Thailand and many Latin American countries, had instituted
at least an embryonic form of maternal and infant health
services by the onset of the 20th century. The First World
War accelerated the movement. Josephine Baker, then Chief
of the Division of Child Hygiene of New York, summed it up
as follows:

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One of the first maternal and child health clinics, in the late
19th century, were‘L’OEuvre de la goutte de lait’: Dr Variot’s
consultation at the Belleville Dispensary, Paris.

“It may seem like a cold-blooded thing to say,

but someone ought to point out that the World War was a
back-handed break for children ... As more and more
thousands of men were slaughtered every day, the
belligerent nations, on whatever side, began to see that new
human lives, which could grow up to replace brutally
extinguished adult lives, were extremely valuable national
assets. [The children] took the spotlight as the hope of the
nation. That is the handsomest way to put it. The ugliest way
– and, I suspect, the truer – is to say flatly that it was the
military usefulness of human life that wrought the change.
When a nation is fighting a war or preparing for another ... it
must look to its future supplies of cannon fodder”.

Caring for the health of mothers and children

soon gained a legitimacy of its own, beyond military and
economic calculations. The increasing involvement of a
variety of authorities – medical and lay, charitable and

9
governmental – resonated with the rising expectations and
political activism of civil society (1). Workers’ movements,
women’s groups, charities and professional organizations
took up the cause of the health of women and children in
many different ways. For example, the International Labour
Organization proposed legal standards for the protection of
maternity at work in 1919; the New York Times published
articles on maternal mortality in the early 1930s; and in
1938 the Mothers’ Charter was proclaimed by 60 local
associations in the United Kingdom. Backed by large
numbers of official reports, maternal and child health
became a priority for ministries of health. Maternal and child
health programmes became a public health paradigm
alongside that of the battle against infectious diseases.
These programmes really started to gain ground after the
Second World War. Global events precipitated public interest
in the roles and responsibilities of governments, and the
Universal Declaration of Human Rights in 1948 by the newly
formed United Nations secured their obligation to provide
“special care and assistance” for mothers and children .This
added an international and moral dimension to the issue of
the health of mothers and children, representing a huge step
forward from the political and economic concerns of 50 years
earlier. One of the core functions assigned to the World
Health Organization in its Constitution of 1948 was “to
promote maternal and child health and welfare” .By the
1950s, national health plans and policy documents from
development agencies invariably stressed that mothers and
children were vulnerable groups and therefore priority
“targets” for public health action. The notion of mothers and
children as vulnerable groups was also central to the primary
health care movement launched at Alma-Ata (now Almaty,
Kazakhstan) in 1978.
This first major attempt at massive scaling up of health
care coverage in rural areas boosted maternal and child
health programmes by its focus on initiatives to increase
immunization coverage and to tackle malnutrition, diarrhea
and respiratory diseases. In practice, child health

10
programmes were usually the central – often the only –
programmatic content of early attempts to implement
primary health care.
3. WHERE WE ARE NOW: A MORAL
AND
POLITICAL
IMPERATIVE

The early implementation of primary

health care often had a narrow focus, but among its merits
was the fact that it laid the groundwork for linking health to
development and to a wider civil society debate on
inequalities. The plight of mothers and children soon came to
be seen as much more than a problem of biological
vulnerability. The 1987 Call to Action for Safe Motherhood
explicitly framed it as “deeply rooted in the adverse social,
cultural and economic environments of society, and
especially the environment that societies create for
women” .Box 1.1 recalls some important milestones in
establishing the rights of women and children.
In this more politicized view, women’s
relative lack of decision-making power and their unequal
access to employment, finances, education, basic health
care and other resources are considered to be the root
causes of their ill-health and that of their children.
Poor nutrition in girls, early onset of sexual activity and
adolescent pregnancy all have consequences for well-being
during and after pregnancy for both mothers and children.
Millions of women and their families live in a social
environment that works against seeking and enjoying good
health. Women often have limited exposure to the
education, information and new ideas that could spare them
from repeated childbearing and save their lives during
childbirth. They may have no say in decisions on whether to
use contraception or where to give birth. They may be

11
reluctant to use health services where they feel threatened
and humiliated by the staff, or pressured to accept
treatments that conflict with their own values and customs
(13). Poverty, cultural traditions and legal barriers restrict
their access to financial resources, making it even more
difficult to seek health care for themselves or for their
children. The unfairness of this situation has made it obvious
that the health of mothers and children is an issue of rights,
entitlements and day-to-day struggle to secure these
entitlements.
The shift to a concern for the rights of
women and children was accelerated by the International
Conference on Population and Development, held in Cairo,
Egypt, in 1994. The conference produced a 20-year plan of
action that focused on universal access to reproductive
health services (of which maternal and child health care
became a subset), which was grounded in individual choices
and rights. This change in perspective is important, because
it alters the rationale for investing in the health of mothers
and children.
Today, more is known than ever before
about what determines the health of women and children
and about which interventions bring about improvements
most cost effectively.
This knowledge makes investment more successful and
withholding care even less acceptable. The health of
mothers and children satisfies the classical criteria for
setting public health priorities (see Box 1.2). Compelling as
these arguments may be, however, they miss two vital
points.

BOX 1.1
Over the past two decades United Nations
bodies, as well as international, regional and national courts,
have increasingly focused on the human rights of mothers
and children.

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 The Universal Declaration of Human
Rights states that “motherhood and childhood are entitled
to special care and assistance”.1948
The General Conference of the
International Labour Organization adopts the Maternity
Protection Convention.1952
The Declaration of the Rights of the
Child.1959
The International Covenant on
Economic, Social and Cultural
Rights recognizes the right to the highest attainable
standard of physical and mental health.1966
The Convention on the Elimination of All
Forms of Discrimination
Against Women enjoins States parties to ensure
appropriate maternal health services.1981
The Convention on the Rights of the
Child guarantees children’s right to health. States commit
themselves to ensuring appropriate maternal health
services.1989
At the United Nations World Summit on
Children governments declare their “joint commitment ... to
give every child a better future”, and recognize the link
between women’s rights and children’s well-being.1990
The United Nations Human Rights
Committee expresses concern over high rates of maternal
mortality.1993
The United Nations International
Conference on Population and Development
United Nations Fourth World
Conference on Women affirm women’s right of access to
appropriate health care services in pregnancy and childbirth.
1995
The United Nations United Nations
Human Rights Committee rules that, when abortion gives
rise to a criminal penalty even if a woman is pregnant as a
result of rape, a woman’s right to be free from inhuman and
degrading treatment might be violated. 1996

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 The United Nations Committee on
Economic, Social and Cultural Rights states that
measures are required to “improve child and maternal
health, sexual and reproductive health services”.2000
The United Nations Committee on the
Rights of the Child states that adolescent girls should
have access to information on the impact of early marriage
and early pregnancy and have access to health services
sensitive to their needs and rights. 2003
The United Nations Commission on Human
Rights, states that sexual and reproductive health are
integral elements of the right to health. 2003
The United Nations Committee against
Torture calls for an end to the extraction of confessions for
prosecution purposes from women seeking emergency
medical care as a result of illegal abortion.
The United Nations Special Rapporteur on
the Right to Health reports that all forms of sexual
violence are inconsistent with the right to health. 2004
The United Nations Sub-Commission on
the Promotion and Protection of Human Rights adopts
a resolution on “harmful traditional practices affecting the
health of women and the girl child”. 2004

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Child health programmes were central to early attempts to
implement primary health care.
Here a community nurse in Thailand watches as a mother
weighs her baby.

BOX 1.2 WHY INVEST PUBLIC MONEY IN

HEALTH CARE FOR MOTHERS AND CHILDREN?
Modern states guarantee health
entitlements for mothers, newborns and children that are
grounded in human rights conventions. Ensuring them
access to care has become a moral and political imperative,
which also has a strong rational basis.
From a public health point of view an
important criterion for priority setting and public funding is
that cost-effective intervention packages exist. Such
packages are well documented in the case of maternal and
child health. But cost-effectiveness is only one of the criteria
for public investment. Others commonly used include: the
generation of positive externalities; the production of public
goods and the rule of rescue; and the potential to increase
equity and avoid catastrophic expenditure. Any of these
criteria can be a sufficient condition for public investment on
its own. When more than one is present, as in maternal

15
and child health interventions, the case for public funding is
even stronger.
Health care for mothers and children
produces obvious positive externalities through vaccination
or the treatment of the infectious diseases of childhood, and
through the improved child health that follows improvement
of maternal health. There has been little systematic research
on the human, social and economic capital generated by
improving the health of mothers and children, but the
negative externalities of ill-health are clear.
The health of mothers is a major determinant of that of their
children, and thus indirectly affects the formation of human
capital.
Motherless children die more
frequently, are more at risk of becoming malnourished and
less likely to enroll at school. The babies of ill or
undernourished pregnant women are more likely to have a
low birth weight and impaired development. Birth-weight
children in turn are at greater risk of dying and of suffering
from infections and growth retardation, have lower scores on
cognitive tests and may be at higher risk of developing
chronic diseases in adulthood.
Healthy children are at the core of the formation of human
capital. Child illnesses and malnutrition reduce cognitive
development and intellectual performance, school enrolment
and attendance, which impair final educational achievement.
Intrauterine growth retardation and
malnutrition during early childhood have long-term effects
on body size and strength with implications for productivity
in adulthood. In addition, with the death or illness of a
woman, society loses a member whose labour and activities
are essential to the life and cohesion of families and
communities. Healthy mothers have more time and are more
available for the social interaction and the creation of the
bonds that are the prerequisite of social capital.
They also play an important social role in
caring for those who are ill.

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The economic costs of poor maternal and child health are
high; substantial savings in future expenditure are likely
through family planning programmes and interventions that
improve maternal and child health in the long term.
Consequent gains in human and social capital translate into
long-term economic benefits. There is evidence of economic
returns on investment in immunization, nutrition
programmes , interventions to reduce low birth weight , and
integrated health and social development programmes
Maternal and child health programmes are
also prime candidates for public funding because they
produce public goods. Although many Low maternal and
child health interventions can be classified as private goods,
a comprehensive programme also includes components such
as information on contraception, on sexual health and rights,
on breastfeeding and child care, that are obvious public
goods. Moreover, the rule of rescue, which gives priority to
interventions that save lives, applies to many maternal and
child health interventions.
Finally, public funding for maternal and
child health care is justified on grounds of equity.
Motherhood and childhood are periods of particularly high
vulnerability that require “special care and assistance”; they
are also periods of high vulnerability because women and
children are more likely to be poor. Although systematic
documentation showing that they are overrepresented
among the poor is scarce, women are more likely to be
unemployed, to have lower wages, less access to education
and resources and more restricted decision-making power,
all of which limit their access to care. Public investment in
maternal and child health care is justified in order to correct
these inequities. In addition, where women and children
represent a large proportion of the poor, subsidizing health
services for them can be an effective strategy for income
redistribution and poverty alleviation. Ill-health among
mothers and children, and particularly the occurrence of
major obstetric problems, is largely unpredictable and can
lead to catastrophic expenditures that may push households

17
into poverty. The risk of catastrophic expenditures is often a
deterrent for the timely uptake of care – a major argument,
technically and politically, for public investment.
First, children are the future of society, and
their mothers are guardians of that future. Mothers are much
more than caregivers and homemakers, undervalued as
these roles often are. They transmit the cultural history of
families and communities along with social norms and
traditions. Mothers influence early behaviour and establish
lifestyle patterns that not only determine their children’s
future development and capacity for health, but shape
societies. Because of this, society values the health of its
mothers and children for its own sake and not merely as a
contribution to the wealth of the nation (48).
Second, few consequences of the
inequities in society are as damaging as those that affect the
health and survival of women and children. For governments
that take their function of reducing inequality and
redistributing wealth seriously, improving the living
conditions and providing access to health care for mothers
and children are good starting points. Improving their health
is at the core of the world’s push to reduce poverty and
inequality.

4. UNEVEN GAINS IN CHILD

HEALTH

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 Being healthy means
much more than merely surviving. Nevertheless, the
mortality rates of children under five years of age provide a
good indicator of the progress made or the tragic lack of it.
Under-five mortality rates fell worldwide throughout the
latter part of the 20th century: from 146 per 1000 in 1970 to
79 per 1000 in 2003. Since 1990, this rate has dropped by
about 15%, equating to more than two million lives saved in
2003 alone. Towards the turn of the millennium, however,
the overall downward trend was showing signs of slowing.
Between 1970 and 1990, the under-five mortality rate
dropped by 20% every decade; between 1990 and 2000 it
dropped by only 12%.
The slowing down of
progress started in the 1980s in the WHO African and
Western Pacific Regions, and during the 1990s in the Eastern
Mediterranean Region. The African Region started out at the
highest levels; saw the smallest reductions (around 5% by
decade between 1980 and 2000) and the most marked
slowing down. In contrast, progress continued or accelerated
in the WHO Region of the Americas, and the South-East Asia
and European Regions. The result is that the differences
between regions are growing. The under-five mortality rate
is now seven times higher in the African Region than in the
European Region; the rate was “only” 4.3 times higher in
1980 and 5.4 times higher in 1990. Child deaths are
increasingly concentrated in the African Region (43% of the
global total in 2003, up from 30% in 1990). As 28% of child
deaths still occur in South-East Asia, two of the six WHO
regions – Africa and South-East Asia – account for more than
70% of all child deaths. Looking at it another way, more than
50% of all child deaths are concentrated in just six countries:
China, the Democratic Republic of the Congo, Ethiopia, India,
Nigeria and Pakistan.

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5. FEW SIGNS OF IMPROVEMENT IN
MA
TERNAL HEALTH

Pregnancy and childbirth and their

consequences are still the leading causes of death, disease
and disability among women of reproductive age in
developing countries – more than any other single health
problem. Over 300 million women in the developing world
currently suffer from short-term or long-term illness brought
about by pregnancy and childbirth; 529 000 die each year
(including 68 000 as a result of an unsafe abortion), leaving
behind children who are more likely to die because they are
motherless. There have been few signs of global
improvement in this situation. However, during the 1960s
and 1970s, some countries did reduce their maternal
mortality by half over a period of 10 years or less. A few
countries such as Bolivia and Egypt have managed this in
more recent years. Other countries appear to have suffered
reversals. Recent success stories in maternal health are less
often heard than those for child health. This is partly
because it takes longer to show results, partly because
changes in maternal mortality are much more difficult to
measure with the sources of information available at
present. Today, predictably, most maternal deaths occur in

20
the poorest countries. These deaths are most numerous in
Africa and Asia. Less than 1% of deaths occur in high-income
countries. Maternal mortality is highest by far in sub-Saharan
Africa, where the lifetime risk of maternal death is 1 in 16,
compared with 1 in 2800 in rich countries. Information on
maternal mortality remains a serious problem. In the late
1970s, less than one developing country in three was able to
provide data – and these were usually only partial hospital
statistics.
The situation has now improved but births and
deaths in developing countries are often only registered for
small portions of the population except in some Asian and
Latin American countries. Cause of death is routinely
reported for only 100 countries of the world, covering one
third of the world’s population. It is even difficult to obtain
reliable survey data that are nationally representative. For
62 developing countries, including most of those with very
high levels of mortality, the only existing estimates are
based on statistical modeling. These are even more
hazardous to interpret than those from surveys or partial
death registration. The countries that rely on these modeled
estimates represent 27% of the world’s births. Effectively,
this leaves no record of the fate of 36 million – about 1 out of
4 – of the women who give birth every year.
Gradual improvements in data availability,
however, mean that a growing database now exists of
maternal mortality by country. Since 1990, a joint working
group of WHO, the United Nations Children’s Fund (UNICEF)
and the United Nations Population Fund (UNFPA) has been
regularly assessing and synthesizing the available
information . It has not been possible, though, to assess
changes over time with any confidence the uncertainty
associated with maternal mortality estimates makes it
difficult to say whether that mortality has gone up or down,
so no global downturn in maternal mortality ratios can yet be
asserted.
Nevertheless, there is a sense of progress,
backed by the tracking of indicators that point to significant

21
increases in the uptake of care during pregnancy and
childbirth in all regions except sub-Saharan Africa during the
1990s. The proportion of births assisted by a skilled
attendant rose by 24% during the 1990s, caesarean sections
tripled and antenatal care use rose by 21%. Since
professional care is known to be crucial in averting maternal
deaths as well as in improving maternal health, maternal
mortality ratios are likely to be declining everywhere except
for those countries which started the 1990s at high levels.
For these, which are mainly in sub-Saharan Africa, there has
been no sign of progress.

Box 3.
Malawi is one country that experienced a
significant reversal in maternal mortality: from 752 maternal
deaths per 100 000 live births in 1992 to 1120 in 2000,
according to the Malawi Demographic and Health Surveys.
According to confidential enquiries into maternal deaths in
health facilities in 1989 and 2001, three factors apparently
contributed to this increase. First, there was a sharp
proportional increase in deaths from AIDS. This is not
surprising since Malawi’s national HIV prevalence has now
reached 8.4%. Second, fewer mothers gave birth in health
facilities: the proportion dropped from 55% to 43% between
2000 and 2001. Third, the quality of care within health
facilities deteriorated. Between 1989 and 2001 the
proportion of deaths associated with deficient health care
increased from 31% to 43%. In 2001 only one mother out of
four who died in the hospital had received standard care.
Wrong diagnosis (11% of deaths), delays in starting
treatment (19%), wrong treatment (16%), or lack of blood for
transfusion (18%): deficient hospital care was the leading
principal avoidable factor in 38% of deaths.
The diminishing coverage and the worsening of
the quality of care are related to the deteriorating situation
of the health workforce (itself not independent from the
HIV/AIDS epidemic). In remote areas one midwife often has
to run the entire rural health centre and is expected to be

22
available for work day and night, seven days a week. One
maternity unit out of 10 is closed for lack of staff. Hospitals
also experience severe shortages of midwives, and unskilled
cleaners often conduct deliveries. The shortage of staff in
maternity units is catastrophic and rapidly getting worse; the
chances of Malawi women giving birth in a safe environment
diminish accordingly.

II. A continuum of care to save

newborn lives

The global community recently declared a

commitment to “create an environment—at the national and
global levels alike—which is conducive to development and
to the elimination of poverty”.1 This declaration led to an
agreement on eight goals in key areas of global concern: the
Millennium Development Goals. Central among those goals
are two that aim to reduce maternal and child mortality,
goals 4 and 5. Investment in maternal, newborn, and child
health is not only a priority for saving lives, but is also critical
to advancing other goals related to human welfare, equity,
and poverty reduction. The United Nations has led the global
community in articulating a rights-based approach to health,
giving special attention to mothers and children. The
Universal Declaration of Human Rights, ratified in 1948,
states that “motherhood and childhood are entitled to
special care and assistance”.3 The Convention on the Rights
of the Child, ratified in 1989, guarantees children’s right to
the highest attainable standard of health.4 Other
conventions and international consensus documents focus
on redressing the gender-based discrimination that might
undermine good health, particularly that of girls and women.
Only collective responsibility and close coordination among

23
governments, assistance agencies, and civil society will
make achieving these goals possible. The challenge is
significant. Each year: more than 60million women without
skilled care;5 about 515000 women die from pregnancy-
related complications;6 almost 11 million children die before
they reach the age of 5 years;7 of children who die under
the age of 5, 38% die in the first month of life, the neonatal
period, and about three quarters of neonatal deaths occur in
the first week after birth;8 and there are about 4 million
stillbirths. The socioeconomic consequences of maternal,
newborn, and child morbidity and mortality are also
significant. Many conditions, such as obstructed labour or
preterm birth, can cause severe disabilities for survivors,
adding stress to already fragile communities and health
systems. A mother’s death or illness can jeopardize an entire
family’s well-being; the care required for disabled or sick
children burdens families; and the loss of current or future
earnings exacerbates the cycle of poverty and poor health
for families and societies.10
The burden of maternal, newborn, and
child mortality falls disproportionately on the world’s poorest
countries and on the poorest populations. Within most low-
income countries, child mortality rates, for example, are
several times higher in the poorest 20% of the population
than the richest and yet access to care, such as skilled
attendance, is lowest for those most in need.11
Despite the health burden, availability of
cost-effective interventions, and the human rights
imperative, maternal, newborn, and child health needs have
lost out over the past decades. Investment is pitifully low
given the size of the problem, available cost-effective
interventions, and potential gains. Competition between
advocates has weakened their collective voice, splitting
support for the maternal and child health agenda.
In the struggle for resources, priorities have been
determined all too often on political grounds rather than
need and potential impact. For example, the package of
interventions that would best reduce mortality in women and

24
also in newborn infants—female education, family planning,
community-based maternity care, and referral services for
women with obstetric complications— has received
inadequate resources and attention from global policy-
makers and national decision-makers.
As a result, as resources are directed
elsewhere, millions of women continue to endure the risks of
childbearing under appalling conditions and babies continue
to die unnecessarily.
The interventions most likely to reduce
child deaths also do not reach those most in need. During
the 1980s, the international community created the impetus
for a child survival revolution, triggering progress in reducing
child mortality. However, since then, progress has stalled
and in some countries even reversed. In 2003, the Bellagio
Child Survival group published a series in The Lancet as an
urgent call for action, indicating the need for a second
revolution in child survival. This series has had far-reaching
effects at global and national levels.
Until recently, the health of newborn
babies was virtually absent from policies, programmes, and
research in the developing world, although 4 million newborn
babies die each year. This issue of The Lancet sees the
publication of the first paper, in a series of four, that places
newborn babies and their care firmly in the spotlight,
highlighting neonatal deaths and cost-effective interventions
appropriate for use, particularly where most newborn infants
are born and die—at home.8 This series includes new
analyses produced through a year of teamwork by a wide
group of academics, agencies, and non-governmental
organizations. The time has come for these health
interventions for newborn babies to be integrated into
maternal and child health programmes, which in turn need
to be strengthened and expanded. Proven cost-effective
interventions, delivered through a continuum-of-care
approach, can prevent millions of needless deaths and
disabilities. The continuum-of-care approach promotes care
for mothers and children from pregnancy to delivery, the

25
immediate postnatal period, and childhood, recognizing that
safe childbirth is critical to the health of both the woman and
the newborn child and that a healthy start in life is an
essential step towards a sound childhood and a productive
life. Another related continuum is required to link households
to hospitals by improving home-based practices, mobilizing
families to seek the care they need, and increasing access to
and quality of care at health facilities. For example, India has
taken the lead in developing a strategy for Integrated
Management of Neonatal and Childhood Illness, which
extends the earlier strategy, to reach the newborn child as
well as older children, and includes home visits as well as
facility-based care. And international organizations have
joined forces to create three partnerships for safe
motherhood, the health of newborn babies, and child
survival. To maximize effectiveness, the partnerships have
now formed a consortium and are working towards full
integration.
First, the partnerships are coordinating
their advocacy efforts to promote the continuum of care for
maternal, newborn, and child health, and to mobilize the
additional resources needed to meet the targets of
Millennium Development Goals 4 and 5.
Second, they are joining in national-level
planning meetings to support countries’ efforts to accelerate
high and equitable coverage of evidence-based maternal,
newborn, and child health interventions.
Third, the partnerships are planning a
high-level global meeting on World Health Day, in Delhi, with
the Government of India. The aim of the meeting is to
mobilize national and international commitment to the
integrated maternal, newborn, and child health agenda, and
facilitate coordinated programming, emphasizing the south
Asian and African regions. The meeting is building on the
launch of the World Health Report 2005, which focuses on
maternal, newborn, and child health.
Fourth, they will promote accountability at
the international level and are considering the possibility of

26
biannual conferences as a mechanism to track and
accelerate progress.

1. Epidemiological transition,
medicalisation of childbirth, and
neonatal mortality: three Brazilian
birth-cohorts
Over the past two decades, Brazil has
seen improvements in women’s nutritional status, education,
smoking habits, and antenatal care. Neonatal mortality rates
(deaths of Live born infants up to 1 month of age), however,
have changed little. In this issue of The Lancet, Fernando
Barros and colleagues present fascinating data from three
birth cohorts who suggest that falling mortality in term
infants (37 weeks’ gestation or more) has been offset by a
rise in preterm births and deaths, resulting in little change in
neonatal mortality. Brazilian health authorities can claim
fairly that more preterm infants survive because of better

27
neonatal care: gestation-specific mortality rates have fallen
by 50% since 1982.
Nonetheless, many preterm deliveries
result from pregnancy interruption, either by caesarean
section or induction. Such early delivery is often a direct
consequence of inappropriate medicalisation. The road to
hell is paved with good intentions, and efforts to improve
prenatal care have often had unintended consequences.
Diethylstilbestrol was used in millions of
pregnancies before its association with vaginal cancer in
offspring was noted. Uncontrolled use of oxygen and
sulphonamides to treat respiratory distress in premature
infants in the 1950s triggered epidemics of retinopathy and
kernicterus, respectively. A proportion of the epidemic of
sudden infant deaths was attributable to pediatricians
encouraging prone sleeping for term infants, drawing
incorrectly on their experience of nursing preterm infants in
this position to avoid aspiration. Arguably the most
pernicious example of medicalisation, however, is the
promotion of formula milks.
The increased health risks of formula
feeding have been well documented in communities where
illiteracy, poverty, and lack of a clean supply of water are the
norm. Formula-fed infants aged under 2 months are nearly
six times more likely to die than breastfed infants,3 but
inappropriate promotion by milk companies remains
widespread.4
Two medical interventions that are
potentially lifesaving, antenatal ultrasonography and
caesarean section, are particularly prone to misuse.

28
 2. Children's Health Rights
in Turkey

The right to health is one of the

significant examples of social rights and includes the tasks
that the state must perform. Citizens should expect positive
things from the state. In Turkey, legally each individual who
is between 0-18 years of age is a child. This paper introduces
some legal rights of children related to medical ethics.
Parents of a child who is under age and mentally retarded
are responsible for giving the necessary education to
him/her (Civil Law clause 264 ).If it is not possible for parents
to take the necessary precautions due the mental disorders
of their children, parents have the right to want the judge to
take necessary precautions and expenses to be paid by the
government (Civil law clause 273).If parents neglect their
responsibilities seriously, it allows maximum interference
with sovereignty of children and in such a case, sovereignty
rights of parents may be taken away by the judge (Civil Law
clause 274). There are also certain sentences concerning
Child Health in Criminal law. From this respect, a parent who
leaves an ailing child belonging to him or her is punished
(Turkish Criminal Law clause 473). Under the Criminal Law,
sexual crimes committed against children are punished more
severely, and if these crimes are committed by those who
have authority on the children, than those persons are
punished much more severely (Turkish Criminal Law clause
415 and 417).
Child abuse and negligence continues to
be one of the most important threats to the healthy and
normal development of children all over the world. First of
all, negligence, in other words "careless taking care of the
children" is a problem or a behavior seen in a family
atmosphere. But, this problem grows up gradually in other
atmospheres as well. Child abuse is a subject that is
evaluated in various disciplines. Medical, legal, psychological

29
and sociological approaches all handle the different
dimensions of this subject. Naturally, it is observed that,
these approaches, even in the description of the "abuse",
are in different dimensions about the subject that includes a
lot of perspectives and a lot of variables. How can we
describe the behaviours that are directed toward the
children and collected under the title of "child abuse" all over
the world? The first question that needs to be asked is which
behaviours are included under the title of "harassment of
children"?
"Behaviours that prevent the healthy and
normal development of a child can be called as "harassment
of children". The answer of the question, "how can they be
encountered?" is: "Child and teenager abuse can either be in
physiological, mental, sexual, emotional or negligence form.
Child abuse is a disease that is related with all parts of the
society." Because there were a lot of descriptions about child
abuse, the World Health Organization assembled experts of
the subject to discuss the matter in 1985 and as a result, the
following description was accepted: "The intentional and
unintentional behaviours which affect a child's physiological
and psycho-social development, towards the children by
adults, society and country are called as child abuse. This
description also includes actions, which a child doesn't
percept and adults don't accept. For behaviour to be a child
abusing subject, this behaviour doesn't need to be percepted
by a child and adults as child abusing subject. (2)."

Children and their Health

Rights

The 25/2nd article of Universal

Declaration of Human Rights expresses that "Motherhood
and childhood are entitled to special care and assistance"
and bases the fundamentals of law studies on mother and
child, which develops day by day and in international field

30
and affects the nations. Children's rights are a concept that
cares about the special conditions of children who are
accepted as the most desperate. All rights, basically, remind
some obligations and responsibilities. These are the
obligations and responsibilities of adults to children,
obligations and responsibilities of powerful people to weak
people.
A basic responsibility of a country is to
protect "rights of living" of its people .providing it depends
on protecting the health rights of the people. Health rights
are described as the right, which provides protection, and
development of an individual's health. Protecting an
individual's health, both directly and via the cooperation of
private enterprise and local administration, is one of the
basic obligations of a country.
People are in very different health standards in our world.
The most affected people from these different standards are
the children. Giving equal opportunity for all people in health
is basic element of being human .A child's health right
begins with the time that she goes into womb. It's related
with the mother health in the first degree during the
pregnancy of the mother and suckling period. Then, it
continues to be related with society's health in different
phases.
A proclamation about "the right of the
children who are hospitalized" published by the world
doctors' Unity Day on 22nd October 1996. Health care of the
hospitalized children has very close relationship with the
processes that affect recovery of the patient such as
medical, social, financial conditions. For that reason, special
care should be taken in the rights of the hospitalized
children. That the evaluating and taking care of the
bitterness that the children suffer and insufficiency of the
treatment on hospitalized children have been well known.
For finding the sources to support these children, it is
necessary to emphasize the hospitalized children's rights for
doctors and public.
For children these include:

31
 The rights of receiving effective
treatment and taking advantages of the present attempts in
order to be saved form the sufferings.
The right of receiving necessary health
care convenient to his/her age and sex and illnesses, taking
advantage of the treatments convenient to the medical
science from the health institutions including private ones.
The right to be able to hospitalize on
time, to be discharged form the hospital as soon as possible.
The right of receiving treatment with
love, convenient to his/her honor and privacy.
The right to be in the recovery process
actively, and to take information from the doctors when it is
possible about his illnesses.
The right to share the same
atmosphere with his age groups and to take the care from
the people who got health education for this age group.
The right to see his parents and other
family members including children, unless doctors prohibit it.
The right to suck his/her mother when
he/she is in the hospital.

32
 III. MOTRHER’S RIGHTS

1. Single mother
assistance
Single mothers are often a very overworked,
highly stressed part of our population. They're often used to
working long hours, sometimes having to juggle one or two
or even three jobs just to make ends meet. The idea of
making rent, bill or other payments on time is often the goal
rather than the typical practice. Because of this, a home loan
for single mother families is, without a doubt, financial
treasure chests for these financially needy women.
A Home loan for single mothers gives single
mothers the financial help they need to move into more
suitable housing for raising a child in, move into a better
neighborhood, and continue to improve their life and the
lives of their children. Any financial relief for these women
can improve their lives.
Because single mothers are in a group of the
population that are in great need of support, a home loan for
single mothers has been created. These loans are giving
single mothers the hope that they can have the home of
their dreams. Though a home loan for single mothers may
not cover the entire cost for better housing, they are a step
in the right direction. Many working people do not have the
same privileged option and so the loans are a specially
crafted to this population. Though loans are available to the
general public, home loans for single mother(s) will include
details specific only to single mothers.

A home loan for single mothers is more than

a special opportunity for single mothers to improve the
housing conditions for their families; it is a wonderful

33
opportunity to have a chance to own a substantial piece of
equity. Real estate equity is an invaluable piece of property
to have ownership of. Especially a house purchased at the
right time, when the market is just right, and when profits
can be easily measured.

A house’s equity, purchased at the right

time, can easily be doubled, tripled and so forth. This
potentiality can not only spring a single mother to an even
greater positive position in her life, it can help inspire more
single mothers to make the move to utilize the home loans
available. Better housing is typically found in better
neighborhoods, which exposes these women and their
children to better atmospheres. A phenomenon that in the
end will only produce an all around more positive life-
changing experience!
With more children growing up in safer, more
tranquil neighborhoods the potential for better growth
personally, mentally, and spiritually can be ten-fold. Home
loans for single mothers are a positive springboard for single
mothers, their children, as well as society as a whole!

2. Mother know your

rights!!!!!!!
Parental responsibility for children
Those with parental responsibility
decide on the important aspects of their children’s lives such
as education, where they will live, medical treatment etc.
Married parents each have parental responsibility which
continues until the child is 18 years old. This is the case
even if you separate or divorce. A step parent can acquire
parental responsibility if s/he marries the parent. An
unmarried mother has sole responsibility for a child unless
she makes a formal agreement with the father of the child,
or there is a court order in favour of the father (which would

34
be granted if the mother was unable to care for the child).
An unmarried father has no automatic parental responsibility
for their child. They can only acquire parental responsibility
by making a formal agreement with the mother by obtaining
a court order, by becoming the child’s guardian or by
marrying the mother. In the very rare situations where those
with parental responsibility appear to be making decisions
that would not be in the child’s best interests (refusing
medical treatment, for example) the courts can intervene to
override a parent’s decision. A child can also decide on
medical treatment for him or herself once s/he is 16 or
younger if the doctor believes that s/he is able to understand
the importance and consequences of such decisions.
Child protection
Under British law, however, parent’s
rights exist to protect the welfare and development of the
child. If these are threatened, or the parents cannot protect
their children, then it is possible that the local authority
social services would seek to take action. They will do so if
they believe it is possible that
the child is being physically abused • the child is being
neglected (not properly fed or clothed or left alone or in
charge of other children when too young to do so)
•the child is being sexually abused or exploited
If social services, health or education
workers have reason to believe that a child needs protection
then a social worker will become involved.
She or he would make contact with the
parents and child fi rst to assess the situation and then to
offer support or to propose further action if it appears that
the parents cannot or will not look after their children well
enough.
Contact with children
Every child born to a married woman is
presumed to be her husband’s child unless there is proof to
the contrary. The husband has the right to enter his name
on the child’s birth certificate, whether or not he is actually
the father.

35
If you separate, you and your partner may make an informal
arrangement for contact with the child. If this is not possible,
a court can be asked to intervene. The court order will
usually allow contact between the child and the parent with
whom the child is not living, unless there are exceptional
circumstances. If this is difficult, it may be possible to get
help from an access centre, where the visits would take
place.
Where a couple is cohabiting, a male partner
is not presumed to be the father of a child. His name can
only appear on the birth certificate if he registers the birth
with the mother. This is regarded as proof of his paternity,
and so he will be responsible for the financial support of the
child, but does not give him any extra rights: for that he
would need a court order or an agreement.
Financial support of
children
Both parents are responsible for supporting
the child financially. When a parent in the UK does not
financially support a child, the Government’s
Child Support Agency can step in to enforce payments. This
is done according to a formula that takes the incomes and
responsibilities of both parents into account. If the parent
looking after the child is on benefits, the money so received
will mostly be deducted from benefits. A parent with
parental responsibility can claim a tax credit for the child,
with extra credit available for certain types of child care
expenses. In the benefits and tax system there are some
allowances made for “single” or “lone” parents who are
bringing up a child on their own. In particular, women with
caring responsibilities may not have to sign on for work in
order to get benefits.
Appointing a Guardian for a
child
A parent can appoint a “guardian” who is
someone who will take over parental responsibility if the
parent dies. In the case of a married couple, either parent
can appoint a guardian to act in the event of both parents

36
dying. Where the parents are cohabiting, a mother can
appoint a guardian to act on her death and a father can
appoint a guardian to act on his death if he has parental
responsibility for the child.

CODE OF GOOD PRACTICE ON THE

PROTECTION OF EMPLOYEES DURING PREGNANCY
AND AFTER THE BIRTH OF A CHILD

1. INTRODUCTION

1.1 Many women work during pregnancy and many return to

work while they are still breast-feeding.

1.2 The objective of this code is to provide guidelines for

employers and employees concerning the protection of the
health of women against potential hazards in their work
environment during pregnancy, after the birth of a child and
while breast-feeding.

2. APPLICATION OF THE CODE

2.1 This code is issued in terms of section 87(1) (b) of the

Basic Conditions of Employment Act (BCEA) 75 of 1997.

2.2 It is intended to guide all employers and employees

concerning the application of section 26(1) of the BCEA
which prohibits employers from requiring or permitting
pregnant or breast-feeding employees to perform work
that is hazardous to the health of the employee or that
of her child.

37
2.3 Workplaces may be affected differently depending
upon the type of business and sector they are engaged
in and the physical, chemical and biological hazards to
which employees may be exposed in the workplace.

2.4 The norms established by this code are general and

may not be appropriate for all workplaces. A departure
from the code may be justified in the proper
circumstances. For example, the number of employees
employed in an establishment may warrant a different
approach.

3. CONTENTS

This code

3.1 sets out the legal requirements relevant to the

protection of the health and safety of pregnant and breast-
feeding employees;

3.2 sets out a method for assessing and controlling the risks
to the health and safety of pregnant and breast-feeding
employees;

3.3 lists the principal physical, ergonomic, chemical and

biological hazards to the health and safety of pregnant
and breast-feeding employees and recommends steps
to prevent or control these risks. These are listed in
Schedules One to Four, which are included for guidance
and are not exhaustive.

4. LEGAL REQUIREMENTS

4.1 The Constitution protects the right to bodily and

psychological integrity, which includes the right to
make decisions concerning reproduction [section 12(2)]
and gives every person the right to health services,
including reproductive health care [section 27(1)(a)].

38
4.2 No person may be discriminated against or
dismissed on account of pregnancy.*

* The relevant provisions establishing this right are

section 9(3) and (4) of the Constitution; section
187(1) of the Labour Relations Act 66 of 1995 and
section 6 of the Employment Equity Act of 1998.

4.3 Employers are required to provide and maintain a

work environment that is safe and without risk to the
health of employees. This includes risks to the
reproductive health of employees. These duties are
established in terms of both the Occupational Health
and Safety Act (OHSA) 85 of 1993 and the Mine Health
and Safety Act (MHSA) 27 of 1996. Key aspects of these
Acts are -

4.3.1 Employers must conduct a risk assessment, which

involves identifying hazards, assessing the risk that
they pose to the health and safety of employees. and
recording the results of the risk assessment.

4.3.2 Employers must implement appropriate measures

to eliminate or control hazards identified in the risk
assessment;

4.3.3 Employers must supply employees with

information about and train them in the risks to their
health and safety and the measures taken to eliminate
or minimise them;

4.3.4 Elected worker health and safety representatives

and committees are entitled to participate in the risk
assessment and control of hazards;

4.3.5 Employees have a duty to take reasonable steps

to protect their own health and safety and that of other
employees.

39
5. PROTECTING THE HEALTH OF PREGNANT AND
BREAST-FEEDING EMPLOYEES

5.1 Section 26(1) of the BCEA prohibits employers from

requiring or permitting a pregnant employee or an
employee who is breast-feeding to perform work that is
hazardous to the health of the employee or the health
of her child. This requires employers who employ
women of childbearing age to assess and control risks
to the health of pregnant or breast-feeding employees
and that of the foetus or child.

5.2 Employers should identify, record and regularly

review -

5.2.1 Potential risks to pregnant or breast-feeding

employees within the workplace;

5.2.2 Protective measures and adjustments to

working arrangements for pregnant or breast-
feeding employees.

5.3 Where appropriate, employers should also maintain

a list of employment positions not involving risk to
which pregnant or breast-feeding employees could be
transferred.*

* In terms of section 26(2) of the BCEA an

employer must offer suitable alternative
employment to an employee during pregnancy if
her work poses a danger to her health or safety or
that of her child or if the employee is engaged in
night work (between 18:00 and 06:00, unless it is
not practicable to do so. Alternative employment
must be on terms that are no less favourable than
the employee's ordinary terms and conditions of
employment.

40
5.4 Employers should inform employees about hazards
to pregnant and breast feeding employees and of the
importance of immediate notification of pregnancy.

5.5 Workplace policies should encourage women

employees to inform employers of their pregnancy as
early as possible to ensure that the employer is able to
identify and assess risks and take appropriate
preventive measures.

5.6 The employer should keep a record of every

notification of pregnancy.

5.7 When an employee notifies an employer that she is

pregnant her situation in the workplace should be
evaluated. The evaluation should include -

5.7.1 An examination of the employee's physical

condition by a qualified medical professional;

5.7.2 The employee's job;

5.7.3 Workplace practices and potential workplace

exposures that may affect the employee.

5.8 If the evaluation reveals that there is a risk to the

health or safety of the pregnant employee or the
foetus, the employer must -

5.8.1 Inform the employee of the risk;

5.8.2 After consulting the employee and her

representative, if any, determine what steps
should be taken to prevent the exposure of the
employee to the risk by adjusting the employee's
working conditions.

5.9 The employee should be given appropriate training

in the hazards and the preventive measures taken.

41
5.10 If there is any uncertainty or concern about
whether an employee's workstation or working
conditions should be adjusted, it may be appropriate in
certain circumstances to consult an occupational health
practitioner. If appropriate adjustments cannot be
made, the employee should be transferred to an
alternative position in accordance with section 26(2) of
the BCEA.

5.11 Employers must keep the risk assessment for

expectant or new mothers under regular review. The
possibility of damage to the health of the foetus may
vary during the different stages of pregnancy. There
are also different risks to consider for workers who are
breast-feeding.

5.12 Arrangements should be made for pregnant and

breast-feeding employees to be able to attend
antenatal and postnatal clinics as required during
pregnancy and after birth.

5.13 Arrangements should be made for employees who

are breast-feeding to have breaks of 30 minutes twice
per day for breast-feeding or expressing milk each
working day for the first six months of the child's life.

5.14 Where there is an occupational health service at a

workplace, appropriate records should be kept of
pregnancies and the outcome of pregnancies, including
any complications in the condition of the employee or
child.

42
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